総 説㩷
片頭痛患者におけるトリプタン無反応例および低反応例への対応 㩷
㩷
ဈ↱⾆㪈㧘⍹ᱜ㪈㧖㧘ේ ৻㪉㧘㩷
ᷡ᳓ବ৻㪈㧘ቝ⟤ାਫ㪈㧘㪊㧘ᧁౝੑ㪋㩷
㪈㧦㩷ᤘᄢቇ⮎ቇㇱ∛ᘒ↢ℂቇᢎቶ㩷
㪉㧦㩷ᤘᄢቇ⮮߇ਐࡂࡆ࠹࡚ࠪࡦ∛㒮 ⚻ౝ⑼㩷
㪊㧦㩷ቝ⟤⣖⚻ᄖ⑼㩷
㪋㧦㩷ᤘᄢቇ⮎ቇㇱ⮎ቇᢎ⢒ផㅴࡦ࠲㩷
㩷
ⷐ ᣦ㩷
㗡∩ߩᕆᕈᦼᴦ≮⮎ߢࠆ࠻ࡊ࠲ࡦߪ㧘ᧄ㇌ߢ↪น⢻ߥ߽ߩߪ㪌ࠅ㧘ᒻߣߒ ߡߪ㪋⒳㘃ࠆ㧚ᶏᄖߢߪࠬࡑ࠻ࡊ࠲ࡦ߿࠽࠻ࡊ࠲ࡦߥߤߩ࠻ࡊ࠲ࡦ߇ߔߢߦ৻⥸↪
ක⮎ຠ㩿㫆㫍㪼㫉㪄㫋㪿㪼㪄㪺㫆㫌㫅㫋㪼㫉㧦㪦㪫㪚㪀ൻߐࠇߡ߅ࠅ㧘ᧄ㇌ߢ߽ᓟ㪦㪫㪚ൻߐࠇࠆน⢻ᕈ߇㜞㧚࠻ࡊ
࠲ࡦߪ⮎࠲ࠗࡒࡦࠣ߇ㆡಾߢߞߡ߽㧘⚂㪊ഀߩᖚ⠪ߢߪലᨐ߇ߥߊ㧘ߎߩࠃ߁ߥ႐วߪ࠻
ࡊ࠲ࡦߩ⒳㘃߿ᒻߩᄌᦝࠍ⹜ߺࠆᔅⷐ߇ࠆ㧚ߘߩߚ㧘⮎ዪ⮎Ꮷߪ࠻ࡊ࠲ࡦ
ߩᔅⷐߥᖚ⠪ߩ್㧘ㆡಾߥ࠻ࡊ࠲ࡦߩㆬᛯ㧘࠻ࡊ࠲ࡦ߇ήലࠆߪലᨐਇචಽ ߥᖚ⠪߳ߩኻᔕ߇ߢ߈ߥߌࠇ߫ߥࠄߥ㧚ᧄ⎇ⓥߢߪ㧘࠻ࡊ࠲ࡦߦࠃࠆᴦ≮ࠍⴕߞߚ 㗡
∩ᖚ⠪߇⮎ᄌᦝߦࠃࠅലᨐ߇ᡷༀߒߚ∝ࠍ⚫ߒ㧘ߐࠄߦ㧘ᓟ㧘⮎ዪ⮎Ꮷ߇ᔅⷐߣߥࠆ
⥃ᐥ⊛್ᢿ⢻ജߦߟߡ⠨ኤߔࠆ㧚㩷 㩷
㪢㪼㫐㩷㪮㫆㫉㪻㫊㧦 㗡∩㧘࠻ࡊ࠲ࡦ㧘⮎ዪ⮎Ꮷ㩷 㩷
✜ ⸒
㗡∩ߩᕆᕈᦼᴦ≮⮎ߢࠆ࠻ࡊ࠲ࡦ
ߪ㧘ࡠ࠻࠾ࡦฃኈ㩿㪌㪄㪟㪫㪈㧮㪆㪈㧰㪀ೝỗ⮎ߢࠅ㧘
⣖ⴊ▤ࠍ❗ߐߖࠆലᨐ߿ਃ⚻⚳ᧃ߆ࠄࠞ
࡞ࠪ࠻࠾ࡦㆮવሶ㑐ㅪࡍࡊ࠴࠼ߥߤߩⴊ▤ᒛ
‛⾰ߩㆆ㔌ࠍᛥߔࠆലᨐߦࠃࠅ㧘 㗡∩ࠍᡷༀ ߔࠆ㧚ߎߩᴦ≮⮎ߩ⊓႐ߦࠃࠅ㧘 㗡∩ᖚ⠪ߩ 㪨㪦㪣㩿㫈㫌㪸㫃㫀㫋㫐㩷㫆㪽㩷㫃㫀㪽㪼㪀ߪᄢ߈ߊᡷༀߐࠇߚ㧚ߒ߆ߒߥ ߇ࠄ㧘ല₸ߪ㪍㪄㪎ഀߦ⇐߹ߞߡ߅ࠅ㧘ᱷࠅߩ⚂㪊
ഀߪήലߢࠆߣႎ๔ߐࠇߡࠆ㪈㪄㪍㪀㧚࠻ࡊ࠲ࡦ
ߪ ᶏ ᄖ ߢ ߪ ߔ ߢ ߦ ৻ ⥸ ↪ ක ⮎ ຠ 㩿㫆㫍㪼㫉㪄㫋㪿㪼㪄㪺㫆㫌㫅㫋㪼㫉㧦㩷 㪦㪫㪚㪀ൻߐࠇߡ߅ࠅ㧘ࠗࠡ
ࠬ㧘ࠝࠬ࠻ࠕߢߪࠬࡑ࠻ࡊ࠲ࡦ㧘࠼ࠗ࠷
ߢߪ࠽࠻ࡊ࠲ࡦ߇ 㪦㪫㪚 ⮎ߣߒߡ⽼ᄁߐࠇߡ
ࠆ㪎㪀㧚㧘ᧄ㇌ߢߪ㧘ࠬࠗ࠶࠴㪦㪫㪚ߩ
ࠬ࠻ߦࠬࡑ࠻ࡊ࠲ࡦߣ࠱࡞ࡒ࠻ࡊ࠲ࡦ߇
ߞߡࠆ߇㧘㪦㪫㪚⮎ߣߒߡߪᧂߛ⽼ᄁߐࠇߡ߅ࠄ ߕ㧘ಣᣇ⮎ߣߒߡߩߺߩ↪ߦ⇐߹ߞߡࠆ㪏㪀㧚 ߒ߆ߒㄭ᧪㧘ᧄ㇌ߢ߽࠻ࡊ࠲ࡦ߇㪦㪫㪚 ൻߐࠇࠆน⢻ᕈ߇ࠅ㧘㪦㪫㪚ൻߐࠇߚ႐ว㧘⮎ዪ
⮎Ꮷߪ࠻ࡊ࠲ࡦߩᔅⷐߥᖚ⠪ߩ್㧘ല ᨐ್ቯߥߤࠍⴕ㧘ㆡಾߥක≮ࠍᖚ⠪ߦឭଏߔࠆ ᔅⷐ߇ࠆ㧚㩷
ᧄ⎇ⓥߢߪ㧘࠻ࡊ࠲ࡦ߇ήല㩿ήᔕ㪀
ࠆߪലᨐ߇ਇචಽ㩿ૐᔕ㪀ߩᖚ⠪ߦኻߒߡ㧘࠻
㻌
ࡊ࠲ࡦࠍᄌᦝߒᔕᕈߩᡷༀ߇ࠄࠇ ߚ∝ߦߟߡႎ๔ߒ㧘࠻ࡊ࠲ࡦ߇ᧄ㇌ߢ 㪦㪫㪚 ൻߐࠇߚ㓙ߦ⮎ዪ⮎Ꮷ߇ᔅⷐߣߥࠆ⥃ᐥ
⊛್ᢿ⢻ജߦߟߡ⠨ኤߔࠆ㧚㩷
ᣇ ᴺ
㧝㧚 㗡∩ᖚ⠪㩷
㪉㪇㪇㪍ᐕ㪍㨪㪉㪇㪈㪇ᐕ㪈㪉ߦቝ⟤⣖⚻ᄖ⑼㧘 ᤘᄢቇ⮮߇ਐࡂࡆ࠹࡚ࠪࡦ∛㒮⚻ౝ
⑼ߦߡ࿖㓙㗡∩ಽ㘃╙㪉 㩿㪠㪚㪟㪛㪄㪠㪠㪀ߦࠃࠅ 㗡∩
ߣ⸻ᢿߐࠇߚᖚ⠪ߩ߁ߜ㧘࠻ࡊ࠲ࡦ㍤㩿ࠬࡑ࠻
ࡊ࠲ࡦ㧘࠱࡞ࡒ࠻ࡊ࠲ࡦ㧘ࠛ࠻ࡊ࠲ࡦ㧘
ࠩ࠻ࡊ࠲ࡦ㧘࠽࠻ࡊ࠲ࡦ㪀߇ಣᣇߐࠇ㧘ലᨐ
್ቯ߇น⢻ߢߞߚᖚ⠪ࠍኻ⽎ߣߒߚ㧚㪉㪇ᱦᧂḩ
߹ߚߪ㪎㪇ᱦએߩᖚ⠪㧘߁ߟ∛ߩᣢᓔ߇ࠆᖚ⠪㧘
↹ᬌᩏߦࠃࠅ⣖ߦེ⾰⊛∔ᖚߩࠄࠇߚᖚ
⠪ߪ㒰ᄖߒߚ㧚ߥ߅ᧄ⎇ⓥߪ㧘ᤘᄢቇࡅ࠻ࠥࡁ ࡓㆮવሶ⸃ᨆ୶ℂክᩏᆔຬળߩᛚࠍᓧߚᓟ㧘 㗡∩⊒∝߅ࠃ߮࠻ࡊ࠲ࡦߩ⮎‛ᔕᕈߦ 㑐ਈߔࠆ࿃ሶߩត⚝⎇ⓥ㪐㧘㪈㪇㪀 ߩ৻ㇱߣߒߡታᣉ ߒߚ㧚㩷
㩷
㧞㧚࠻ࡊ࠲ࡦߩ⮎‛ᔕᕈߩᬌ⸛㩷
࠻ࡊ࠲ࡦߩലᨐ್ቯߪ㧘એਅߩၮḰߦࠃ ࠅⴕߞߚ㧚ޟᔕޠߪ㧘࠻ࡊ࠲ࡦ↪㪉ᤨ
㑆ᓟߩ∩ߺߩᶖᄬ߹ߚߪ㪋ᤨ㑆ᓟߩᡷༀ㩿↢ᵴߦᡰ 㓚߇ߥ⒟ᐲ㪀߇㪊࿁ߩ↪ߩ߁ߜዋߥߊߣ߽㪉࿁
એߢࠄࠇߚ႐ว㧘ޟήᔕޠߪ㧘࠻ࡊ
࠲ࡦࠍ㪊࿁↪ߒߚ߇㧘㪊࿁ߣ߽ήലߛߞߚ႐ วߣߒߚ㧚߹ߚ㧘ޟᔕޠߩᖚ⠪ߢ⮎ߩᄌᦝ ߦࠃࠅ㧘ࠃࠅ⦟ലᨐ߇ࠄࠇߚ႐ว㧘ᄌᦝ೨ ࠍޟૐᔕޠߣߒߚ㧚ߥ߅㧘ㅊടᛩਈࠍ⹜ߺߚ ᖚ⠪߿ઁߩ㎾∩⮎ߥߤࠍㅊട↪ߒߚᖚ⠪߇
ࠆ߆ߤ߁߆ߪᛠីߢ߈ߡߥ㧚㩷
⚿ ᨐ
㧝㧚ήᔕߢߩ⮎ᄌᦝ㩷
∝ᢙߪ㪌㪎ߢ㧘ߘߩ߁ߜήᔕߪ㪈㪉ߛߞ ߚ㧚ήᔕߩ߁ߜ⮎ᄌᦝߦࠃࠅലᨐ߇ᓧࠄࠇ ߚ㪌ߩ⮎ᄌᦝࡄ࠲ࡦࠍ㪈ߦ␜ߒߚ㧚ᖚ⠪㪌
ߩౝ⸶ߪ㧘ᅚᕈ㪋㧘↵ᕈ㪈㧘㗡∩ߩ⒳㘃ߪ㧘
೨ళߩࠆ 㗡∩߇㪈㧘೨ళߩߥ 㗡∩߇㪋
ߢߞߚ㧚㪈⋡ߣߒߡ㧘ࠩ࠻ࡊ࠲ࡦ㩿㪉㪀㧘
ࠬࡑ࠻ࡊ࠲ࡦ㩿㪉㪀㧘࠱࡞ࡒ࠻ࡊ࠲ࡦ㩿㪈㪀ࠍ
↪ߒߚ߇ήലߢߞߚ㧚ࠩ࠻ࡊ࠲ࡦήᔕ
㩿㪉㪀ߪࠬࡑ࠻ࡊ࠲ࡦ߳ߩᄌᦝߢ㧘࠱࡞ࡒ࠻ࡊ
࠲ࡦήᔕ㩿㪈㪀ߪࠩ࠻ࡊ࠲ࡦ߳ߩᄌᦝߢ ലᨐ߇ࠄࠇߚ㧚ࠬࡑ࠻ࡊ࠲ࡦήᔕ㩿㪉㪀 ߪ㧘ࠩ࠻ࡊ࠲ࡦߦࠃࠅ㪈ߢߪലᨐ߇ࠄ ࠇߚ߇㧘㪈ߪήലߛߞߚ㧚ࠩ࠻ࡊ࠲ࡦߢ߽
ήലߛߞߚ㪈ߪ㧘㪊⋡ߦ⹜ߒߚ࠱࡞ࡒ࠻ࡊ࠲
ࡦߢലᨐ߇ࠄࠇߚ㧚㩷 㩷
㧞㧚ૐᔕߢߩ⮎ᄌᦝ㩷
ૐᔕ㪈㪋ߩ࠻ࡊ࠲ࡦߩᄌᦝࡄ࠲
ࡦࠍ㪉ߦ␜ߒߚ㧚㪈㪋ߩ߁ߜ㧘ᅚᕈߪ㪈㪉㧘↵
ᕈߪ㪉㧘㗡∩ߩ⒳㘃ߪ㧘೨ళߩࠆ 㗡∩߇㪍㧘 ೨ళߩߥ 㗡∩߇㪏ߢߞߚ㧚㪈⋡ߦࠬࡑ࠻
ࡊ࠲ࡦࠍ↪ߒߚߩߪ㪋ߢ㧘㪉⋡ߦࠛ࠻
ࡊ࠲ࡦ㩿㪉㪀߹ߚߪࠩ࠻ࡊ࠲ࡦ㩿㪉㪀߳ߣᄌᦝ ߒ㧘㪈⋡ߣᲧセߒߡࠃࠅ⦟ലᨐ߇ࠄࠇߚ㧚 㪈⋡ߦ࠱࡞ࡒ࠻ࡊ࠲ࡦࠍ↪ߒߚ㪉ߩ߁ߜ㧘 㪈ߪ㪉⋡ߦ↪ߒߚࠩ࠻ࡊ࠲ࡦߦࠃࠅ㧘⦟
ᅢߥᔕ߇ࠄࠇߚ㧚߽߁㪈ߪ㪉⋡ߦಣᣇߐ ࠇߚࠬࡑ࠻ࡊ࠲ࡦߢ↪߇ࠅലᨐ߽ਇච ಽߢߞߚߚ㧘ߐࠄߦ࠽࠻ࡊ࠲ࡦ߳ᄌᦝߒ ߚ⚿ᨐ㧘ࠃࠅ⦟ലᨐ߇ࠄࠇߚ㧚㪈⋡ߦ
ࠩ࠻ࡊ࠲ࡦ߇ಣᣇߐࠇߚ㪏ߪ㧘㪉⋡ߦࠬࡑ࠻
ࡊ࠲ࡦ㩿㪉㪀㧘ࠛ࠻ࡊ࠲ࡦ㩿㪋㪀㧘࠱࡞ࡒ࠻
ࡊ࠲ࡦ㩿㪈㪀߳ߣᄌᦝߣߥࠅ⦟ᅢߥᔕ߇ࠄ ࠇߚ㧚ࠩ࠻ࡊ࠲ࡦ߇ಣᣇߐࠇߚᱷࠅߩ㪈ߦ ߟߡߪ㧘㪉⋡ߦࠬࡑ࠻ࡊ࠲ࡦߣ࠽࠻ࡊ
࠲ࡦ߇ಣᣇߐࠇ㧘ࠬࡑ࠻ࡊ࠲ࡦߪ㕖⚻ᤨ㧘࠽
࠻ࡊ࠲ࡦߪ⚻ᤨߦ↪ߒ㧘ࠃࠅ⦟ലᨐ߇
ࠄࠇߚ㧚㩷
⠨ ኤ
࠻ࡊ࠲ࡦߪ㧘⒳㘃ߦࠃߞߡᔕᕈߩੱ
Ꮕ߇ᄢ߈ߣ⠨߃ࠄࠇ㧘߭ߣߟߩ࠻ࡊ࠲ࡦ
ߦኻߒߡήᔕ߿ૐᔕߢߞߡ߽ઁߩ࠻ࡊ
࠲ࡦߢߪലߥ႐ว߇ࠆ㪈㪈㪀㧚ᧄ⎇ⓥߢ߽࠻
ࡊ࠲ࡦߩήᔕߣૐᔕߢ㧘࠻ࡊ࠲㩷
㧝 ήᔕߢߩ࠻ࡊ࠲ࡦߩᄌᦝࡄ࠲ࡦ㩷
∝㩷 ͳ㩷
ᕈ
㩷 ᐕ 㦂㩷
೨ళߩ
ή㩷 㪈⋡㩷 㪉⋡㩷 㪊⋡㩷 ᄌᦝߩℂ↱㩷
㪈㩷 㪝㩷 㪊㪊㩷 ή㩷 ࠩ࠻ࡊ࠲ࡦ㩷 ٤ ࠬࡑ࠻ࡊ࠲ࡦ ലᨐ߇ᓧࠄࠇߥ߆ߞߚߚ㩷 㪉㩷 㪝㩷 㪋㪋㩷 ή㩷 ࠬࡑ࠻ࡊ࠲ࡦ㩷 ࠩ࠻ࡊ࠲ࡦ ٤ ࠱࡞ࡒ࠻ࡊ࠲ࡦ ലᨐ߇ᓧࠄࠇߥ߆ߞߚߚ㩷 㪊㩷 㪤㩷 㪌㪈㩷 ή㩷 ࠩ࠻ࡊ࠲ࡦ㩷 ٤ ࠬࡑ࠻ࡊ࠲ࡦ ലᨐ߇ᓧࠄࠇߥ߆ߞߚߚ㩷 㪋㩷 㪝㩷 㪋㪎㩷 ή㩷 ࠱࡞ࡒ࠻ࡊ࠲ࡦ㩷 ٤ ࠩ࠻ࡊ࠲ࡦ ലᨐ߇ᓧࠄࠇߥ߆ߞߚߚ㩷 㪌㩷 㪝㩷 㪌㪉㩷 㩷 ࠬࡑ࠻ࡊ࠲ࡦ㩷 ٤ ࠩ࠻ࡊ࠲ࡦ ലᨐ߇ᓧࠄࠇߥ߆ߞߚߚ㩷 㪤㧦㩷↵ᕈ㪃㩷㪝㧦ᅚᕈ㩷
㧦㩷࠻ࡊ࠲ࡦ♽⮎ࠍ㪊࿁↪ߒߚ߇ޔ㪊࿁ߣ߽ήലߢߞߚ߽ߩ㩷
٤㧦㩷࠻ࡊ࠲ࡦ♽⮎↪㪉ᤨ㑆ᓟߩ∩ߺߩቢోᶖᄬ߹ߚߪ㪋ᤨ㑆ᓟߩᡷༀ㧔↢ᵴߦᡰ㓚߇ߥ⒟ᐲ㧕߇ߞߚ߽ߩ㩷 㩷
㧞 ૐᔕߢߩ࠻ࡊ࠲ࡦߩᄌᦝࡄ࠲ࡦ㩷
∝㩷 ͳ㩷
ᕈ
㩷 ᐕ 㦂㩷
೨ళߩ
ή㩷 㪈⋡㩷 㪉⋡㩷 㪊⋡㩷 ᄌᦝߩℂ↱㩷
㪍㩷 㪝㩷 㪌㪍㩷 ή㩷 ٤ ࠬࡑ࠻ࡊ࠲ࡦ㩷 ٧ ࠛ࠻ࡊ࠲ࡦ㩷 ࠬࡑ࠻ࡊ࠲ࡦߩ↪㧔⣕ജᗵ㧕߇
ߞߚߚ㩷 㪎㩷 㪝㩷 㪋㪐㩷 㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠬࡑ࠻ࡊ࠲ࡦ㧖
㩷 ࠩ࠻ࡊ࠲ࡦߩ↪㧔⌁᳇㧕߇ࠅޔ ലᨐਇචಽߢߞߚߚ㩷
࠽࠻ࡊ࠲ࡦ㩷
㪏㩷 㪤㩷 㪌㪋㩷 㩷 ٤ ࠬࡑ࠻ࡊ࠲ࡦ㩷 ٧ ࠩ࠻ࡊ࠲ࡦ㩷 㩷 ലᨐਇචಽߢߞߚߚ㩷 㪐㩷 㪝㩷 㪋㪐㩷 ή㩷 ٤ ࠬࡑ࠻ࡊ࠲ࡦ㩷 ٧ ࠛ࠻ࡊ࠲ࡦ㩷 㩷 ലᨐਇචಽߢߞߚߚ㩷
㪈㪇㩷 㪝㩷 㪋㪊㩷 ή㩷 ٤ ࠱࡞ࡒ࠻ࡊ࠲ࡦ㩷 ٤ ࠬࡑ࠻ࡊ࠲ࡦ㩷 ٧ ࠽࠻ࡊ࠲ࡦ㩷 ࠬࡑ࠻ࡊ࠲ࡦߩ↪㧔ᖡᔃ㧕߇ࠅޔ ലᨐਇචಽߢߞߚߚ㩷
㪈㪈㩷 㪝㩷 㪋㪇㩷 ή㩷 ٤ ࠬࡑ࠻ࡊ࠲ࡦ㩷 ٧ ࠩ࠻ࡊ࠲ࡦ㩷 㩷 ലᨐਇචಽߢߞߚߚ㩷 㪈㪉㩷 㪝㩷 㪌㪉㩷 ή㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠬࡑ࠻ࡊ࠲ࡦ㩷 㩷 ലᨐਇචಽߢߞߚߚ㩷
㪈㪊㩷 㪝㩷 㪋㪋㩷 㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠬࡑ࠻ࡊ࠲ࡦ㩷 㩷 ࠩ࠻ࡊ࠲ࡦߩ↪㧔ᖡᔃ㧕߇ࠅޔ ലᨐਇචಽߢߞߚߚ㩷
㪈㪋㩷 㪝㩷 㪊㪈㩷 ή㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠛ࠻ࡊ࠲ࡦ㩷 㩷 ലᨐਇචಽߢߞߚߚ㩷 㪈㪌㩷 㪝㩷 㪋㪌㩷 㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠛ࠻ࡊ࠲ࡦ㩷 㩷 ലᨐਇචಽߢߞߚߚ㩷 㪈㪍㩷 㪝㩷 㪍㪌㩷 ή㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠛ࠻ࡊ࠲ࡦ㩷 ലᨐਇචಽߢߞߚߚ㩷 㪈㪎㩷 㪤㩷 㪌㪋㩷 㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠱࡞ࡒ࠻ࡊ࠲ࡦ ലᨐਇචಽߢߞߚߚ㩷 㪈㪏㩷 㪝㩷 㪌㪈㩷 ή㩷 ٤ ࠱࡞ࡒ࠻ࡊ࠲ࡦ㩷 ٧ ࠩ࠻ࡊ࠲ࡦ㩷 ലᨐਇචಽߢߞߚߚ㩷
㪈㪐㩷 㪝㩷 㪌㪉㩷 㩷 ٤ ࠩ࠻ࡊ࠲ࡦ㩷 ٧ ࠛ࠻ࡊ࠲ࡦ㩷 ࠩ࠻ࡊ࠲ࡦߩ↪㧔⌁᳇㧕߇ߞ ߚߚ㩷
㩷
㧖㩷 ࠬࡑ࠻ࡊ࠲ࡦߪ㕖⚻ᤨߩߺޔ࠽࠻ࡊ࠲ࡦ⚻ᤨߩߺ↪㩷 㪤㧦㩷↵ᕈ㪃㩷㪝㧦ᅚᕈ㩷
٤㧦㩷࠻ࡊ࠲ࡦ♽⮎↪㪉ᤨ㑆ᓟߩ∩ߺߩቢోᶖᄬ߹ߚߪ㪋ᤨ㑆ᓟߩᡷༀ㧔↢ᵴߦᡰ㓚߇ߥ⒟ᐲ㧕߇ߞߚ߽ߩ㩷 ٧㧦㩷೨ߩߣᲧセߒߡࠃࠅ⦟ലᨐ߇ᓧࠄࠇߚ߽ߩ㩷
㩷
ࡦߩᄌᦝߦࠃࠅലᨐߩᡷༀ߇ࠄࠇߚ㧚㩷 㩷
㧝㧚ήᔕ߳ߩኻᔕ㩷
ኹᧄߪ㧘ࠬࡑ࠻ࡊ࠲ࡦ㍤ࠍ㪊㪌㪉ߦᛩਈߒ㧘 ήലߢߞߚ㪉㪈ߦኻߒߡ࠱࡞ࡒ࠻ࡊ࠲ࡦ㍤
ࠍᛩਈߒߚߣߎࠈ㧘ήലߪ㪈㪉ߣߥߞߚߣႎ๔ ߒߡࠆ㪈㪉㪀㧚߹ߚ㧘ࠬࡑ࠻ࡊ࠲ࡦ㧘࠱࡞ࡒ࠻
ࡊ࠲ࡦ㧘ࠛ࠻ࡊ࠲ࡦߩ㪊ࠍ↪ߒߚᖚ⠪㪏㪈
ߢߩᬌ⸛ߢߪ㧘㪊ోߡߢലߢߞߚߩߪ㪋㪈
㧘㪉ߦലߢߞߚߩߪ㪊㪇㧘㪈ߦലߢ
ߞߚߩߪ㪐㧘ోߡߢήലߢߞߚߩߪ㪈ߛߌߛ ߞߚ㪈㪊㪀㧚ᧄ⎇ⓥߢ߽㧘࠻ࡊ࠲ࡦߩᄌᦝߦࠃ ߞߡ㧘㪌ߢലᨐ߇ᓧࠄࠇߚ㧚ߎߩ∝ߢߪ㧘
ࠩ࠻ࡊ࠲ࡦ㧘ࠬࡑ࠻ࡊ࠲ࡦ㧘࠱࡞ࡒ࠻ࡊ࠲
ࡦߩ㪊ߩ߁ߜߕࠇ߆ࠍ↪ߒߡ߅ࠅ㧘ᄌᦝࡄ
࠲ࡦߪᖚ⠪ޘߢ⇣ߥࠆߚ㧘ߎߩਛߢࠃࠅ⦟
ᄌᦝࡄ࠲ࡦ߇ߤࠇ߆ࠍ␜ߔߎߣߪߢ߈ߥ
߇㧘㩷 㪈⋡ߢᔕᕈ߇ߥ߆ࠄߣߞߡ߈ࠄ
ߕߦ㧘ߎߩࠃ߁ߥᄌᦝࠍ⹜ߺࠆߎߣߪ㊀ⷐߢࠆ㧚 ᧄ⎇ⓥߢߪ㧘㍤߆ࠄઁߩᒻ߳ߩᄌᦝߦߟߡ ߪᬌ⸛ߒߥ߆ߞߚ߇㧘ࠬࡑ࠻ࡊ࠲ࡦߦߪ㍤ߛ ߌߢߥߊ㧘ὐ㥦ᶧ㧘⊹ਅᵈ߇ࠅ㧘㍤ߢല ᨐਇචಽߢ߽ὐ㥦ᶧ߿⊹ਅᵈߢലᨐ߇ᓧࠄ ࠇࠆ႐ว߇ࠆߣႎ๔ߐࠇߡࠆ㪈㪋㪀㧚㩷
ߥ߅㧘ߤߩ࠻ࡊ࠲ࡦࠍ↪ߒߡ߽ήᔕ ߥ႐ว߿㧘↪ߥߤߢ↪߇࿎㔍ߥ႐วߪ㧘࠻
ࡊ࠲ࡦࠍ↪ߖߕ㧘ࠛ࡞ࠧ࠲ࡒࡦ߿㕖ࠬ࠹
ࡠࠗ࠼ᕈ᛫Ἳ∝⮎㩿ࠕࠬࡇࡦ㧘ࠗࡉࡊࡠࡈࠚࡦ㧘
࠽ࡊࡠࠠࡦߥߤ㪀ߦࠃࠆᴦ≮߇ਛᔃߣߥࠆ㧚ߒ߆ ߒലᕈߪ࠻ࡊ࠲ࡦߦᲧセߔࠆߣૐ㧚ߒߚ߇ ߞߡ㧘㗡∩⊒ߩ㗫ᐲࠍᷫዋߐߖࠆ⋡⊛ߢ੍㒐⮎
ߩᛩਈ߇൘ࠄࠇࠆ㧚੍㒐⮎ߪ⊒߇ߦ㪉࿁એ
ࠆߣㆡᔕ߇⠨ᘦߐࠇࠆ㪈㪌㪀㧚ᧄ㇌ߢߪ㧘Ⴎ㉄ࡠ ࡔࠫࡦߩ࠹࠽ࠬ㫤߿ࡒࠣࠪࠬ㫤㩿㪈ᣣ㊂㪈㪇ঌ㪈ᣣ㪉
࿁㪀ߣࡃ࡞ࡊࡠ㉄ߩ߁ߜ࠺ࡄࠤࡦ㫤㩿㪈ᣣ㊂㪋㪇㪇 㨪㪏㪇㪇ঌ㪈ᣣ㪉㨪㪊࿁㪀ߩߺ㒾߇ㆡᔕߐࠇߡࠆ߇㧘 ࠕࡒ࠻ࡊ࠴ࡦ㧘ࡊࡠࡊࡁࡠ࡞ߥߤ㒾ㆡ ᔕᄖߢ੍㒐⮎ߣߒߡ↪ߐࠇߡࠆ⮎߇ᄙ㪈㪌㪀㧚㩷 㩷
㧞㧚ૐᔕ߳ߩኻᔕ㩷
ᧄ⎇ⓥߢߪ㧘࠻ࡊ࠲ࡦߦࠃࠆലᨐ߇ਇචಽߥ
∝߿↪߇ߒߚ∝ߢઁߦᄌᦝߒߚ ߣߎࠈ㧘ᖚ⠪ߦߣߞߡḩ⿷ߩߊലᨐ߇ᓧࠄࠇߚ
∝߇㪈㪋ߞߚ㧚㪈⋡ߢૐᔕߢߞߚᖚ⠪
ߦߪ㧘㪉⋡ߩㆬᛯߦ㧘ᖚ⠪ߩ㪈⋡↪ᓟߩႎ๔
߿ᗵᗐߥߤ߆ࠄ⮎ലࠍ⹏ଔߒ㧘ᖚ⠪ޘߩ㗡∩ߦ วߞߚ⮎ࠍㆬᛯߔࠆ㧚ૐᔕߩ߁ߜ㪈⋡ߦ ㆬᛯߒߚ⮎ߢᦨ߽ᄙ߆ߞߚߩߪࠩ࠻ࡊ࠲
ࡦ㩿㪏㪀ߢࠅ㧘߹ߚ㪈⋡ߢࠩ࠻ࡊ࠲ࡦએᄖ ߩ࠻ࡊ࠲ࡦ߇ಣᣇߐࠇߚᖚ⠪㪍ߩ߁ߜ㪊
ߢ㧘㪉⋡ߦࠩ࠻ࡊ࠲ࡦ߇ಣᣇߐࠇߚ㧚
ࠩ࠻ࡊ࠲ࡦߪ࠻ࡊ࠲ࡦߩਛߢᦨ߽ലᨐ ߩ⊒߇ᣧߊ㧘ઁߩ࠻ࡊ࠲ࡦߢߪ㪉㍤ᔅⷐߥᖚ
⠪ߦ߅ߡ㪈㍤ߢᴦ≮ߢ߈ࠆ႐ว߇ᄙߊല₸߇ 㜞ߣႎ๔ߐࠇߡࠆߎߣ߆ࠄ㪈㪍㪀㧘ࠩ࠻ࡊ࠲
ࡦߩㆬᛯ߇ᄙߊߥߞߚ㧚∝㪎ߩࠃ߁ߦ㧘㕖⚻
ᤨߩ 㗡∩ߦߪࠬࡑ࠻ࡊ࠲ࡦࠍ㧘⚻ᤨߩ 㗡
∩ߦߪࠬࡑ࠻ࡊ࠲ࡦࠃࠅ߽ඨᷫᦼߩ㐳࠽
࠻ࡊ࠲ࡦࠍ↪ߔࠆߎߣߢ㧘࠻ࡊ࠲ࡦߩࠃࠅ
⦟ലᨐࠍᓧࠄࠇࠆᖚ⠪߽߅ࠅ㧘⮎Ꮷ߽ޘߩ
⮎ߩ․ᓽࠍℂ⸃ߒ㧘ᖚ⠪ߩ㗡∩ߦวࠊߖߚᴦ≮
ࠍឭ᩺ߢ߈ߥߌࠇ߫ߥࠄߥ㧚㩷
㓐∝⁁ߩᖡᔃ߇ᒝߊ㧘ౝ߇࿎㔍ߥ႐ว߿හ ലᕈࠍᦼᓙߒߚ႐วߦߪ㧘ࠬࡑ࠻ࡊ࠲ࡦߩὐ 㥦ᶧ߿⊹ਅᵈ߇ലߢࠆ㪍㧘㪈㪎㪀㧚࠱࡞ࡒ࠻
ࡊ࠲ࡦߣࠩ࠻ࡊ࠲ࡦߩญ⣧ౝㅦṁ㍤㧘ญ⣧ౝ
፣უ㍤ߪ㧘᳓ߥߒߢ↪ߢ߈ࠆߚ㧘ળ⼏ਛ߿
ᬺਛߥߤߦ 㗡∩⊒߇ߎߞߚ႐วߥߤߦ
↪ߢࠆ㧚ߎߩࠃ߁ߦ㧘ലᕈ߿⮎ᗵ㧘ലᨐ⊒
ᤨᦼߥߤߩ㆑ߦࠃࠅ㧘ߕࠇ߆ߩ࠻ࡊ࠲ࡦ
ࠍᅢᖚ⠪߽ዋߥߊߥ㧚⨹ᧁࠄߪ㧘ࠬࡑ࠻
ࡊ࠲ࡦ㧘࠱࡞ࡒ࠻ࡊ࠲ࡦ㧘ࠛ࠻ࡊ࠲ࡦߩ 㪊㑆ߢߩല₸ߦᗧᏅߪߕ㧘ᖚ⠪ੱߢ
⮎ߩᅢߺ߇᭽ޘߢࠆߣႎ๔ߒߡࠆ㪈㪏㪀㧚ߒߚ ߇ߞߡ㧘ᖚ⠪ߦ⒳㘃߆ߩ࠻ࡊ࠲ࡦࠍ⹜ߐ ߖߡ㧘ߘߩਛ߆ࠄലᕈ߿ᖚ⠪ߩ༵ᅢࠍ⠨ᘦߒߡ ᖚ⠪ߦᦨ߽ㆡߒߚ⮎ࠍㆬᛯߔࠆᣇᴺ߽ࠆ㧚ߒ ߆ߒ㧘࠻ࡊ࠲ࡦߪ㜞ଔߢࠅ㧘⮎ߩᄌᦝ ߪᔅⷐᦨዊ㒢ߦߔࠆᔅⷐ߇ࠆߣᕁࠊࠇࠆ㧚㩷 㩷
㧟㧚ᓟߩ⺖㗴㩷
࠻ࡊ࠲ࡦߪၮᧄ⊛ߦߪᕆᕈᦼᴦ≮⮎ߢ
ࠆ߇㧘ᦨㄭߢߪ㧘ඨᷫᦼ߇㐳࠽࠻ࡊ࠲ࡦ ࠍ㧘⚻ᤨ 㗡∩ߦኻߒߡ੍㒐⊛ߦ↪ߔࠆ႐ว ߇ࠅ㩿㒾ㆡᔕᄖ㪀㪈㪐㪀㧘⮎Ꮷߣߒߡᖚ⠪ᜰዉߩ㓙 ߦᔅⷐߥ⠌ᾫߒߡ߅ߊߴ߈ᛩਈᣇᴺߢࠆ㧚⚻
ᤨ 㗡∩ߪ೨ళߩߥ 㗡∩ߦಽ㘃ߐࠇ㧘․ᓽߣ ߒߡߪ㧘㗫ᐲ߇ᄙߊ㧘ౣ⊒ߒ߿ߔ㧘㊀ᐲߢࠆ㧘 ᜬ⛯ᤨ㑆߇㐳㧘ᖡᔃཌྷฯ߇ᄙ㧘ᴦ≮ᛶ᛫ᕈ ߩߎߣ߇ᄙߎߣߥߤ߇ߍࠄࠇࠆ㪉㪇㧘㪉㪈㪀㧚⚻ᤨ
㗡∩ߩ੍㒐≮ᴺߪ㧘⚻㐿ᆎᢙᣣ೨ߩ∩ߊߥ
ᤨᦼ߆ࠄ↪ߔࠆߎߣࠍචಽᖚ⠪ߦ⺑ࠍߔࠆ ᔅⷐ߇ࠆ㧚ߥ߅ᧄ⎇ⓥߢߪ㧘࠽࠻ࡊ࠲ࡦࠍ 㗡∩੍㒐ߣߒߡ↪ߒߡࠆᖚ⠪ߪߥ߆ߞ ߚ㧚㩷
ᶏᄖߣห᭽ߦ࠻ࡊ࠲ࡦ߇ 㪦㪫㪚 ൻߐࠇߚ 㓙ߪ㧘⮎ዪ⮎Ꮷߪ⣖ⴊ▤㓚ኂ߿ᔃ╭᪪Ⴇߥߤߩ ᣢᓔߩή㧘ࡕࡁࠕࡒࡦ㉄ൻ㉂⚛㩿㪤㪘㪦㪀㒖ኂ⮎ߩ
↪ߩήߥߤࠍචಽߦ⏕ߒߚᓟߦ㧘࠻ࡊ࠲
ࡦࠍ⽼ᄁߔࠆߎߣߦߥࠆ㧚ᚒޘ߇㪠㪚㪟㪛㪄㪠㪠ߦ ࠃࠅකᏧ߇ 㗡∩ߣ⸻ᢿߒߚᖚ⠪ߦኻߒߡ㧘ޟ 㗡∩ࠬࠢ࠽ޠ㩿ᣣᏱേߢߩ㗡∩Ⴧᖡ㧘ᖡᔃ㧘 శㆊᢅ㧘⥇ㆊᢅߩ㪋߆ࠄᚑࠆ㧧㗡∩ක≮ផㅴᆔ
ຬળᚑ㪀ߦ࿁╵ߒߡ߽ࠄߞߚߣߎࠈ㧘ࠬࠢ
࠽ߢ㓁ᕈߢߞߚᖚ⠪ߪోຬ㧘ਛ╬ᐲ㨪㊀ᐲߩ
∝ߢߞߚ㪉㪉㪀㧚ߔߥࠊߜ㧘ࠬࠢ࠽ߩ㓁ᕈ ᖚ⠪ߪ࠻ࡊ࠲ࡦߩᔅⷐߥਛ╬ᐲએߩ 㗡∩ࠍߒߡࠆน⢻ᕈ߇㜞ߊ㧘ࠬࠢ࠽ߩ
⚿ᨐߪ࠻ࡊ࠲ࡦߩᔅⷐᕈߩήࠍᬌ⸛ߔ ࠆ㓙ߩ߭ߣߟߩ್ᢿ᧚ᢱߦߥࠆߣᕁࠊࠇࠆ㧚ߔߢ
ߦ 㪦㪫㪚 ߩ࠻ࡊ࠲ࡦ߇⽼ᄁߐࠇߡࠆࠗࠡ
ࠬ㧘ࠝࠬ࠻ࠕ㧘࠼ࠗ࠷ߢߪ㧘⮎ዪߢ⮎
Ꮷ߇࠻ࡊ࠲ࡦࠍ⽼ᄁߔࠆ㓙ߦ 㗡∩ߩ⾰
߇↪ߢߞߚߣႎ๔ߐࠇߡࠆ㪎㪀㧚ᧄ㇌ߢ
߽㧘࠻ࡊ࠲ࡦ߇ 㪦㪫㪚 ൻߐࠇߚ㓙ߦߪߎߩ ࠃ߁ߥขࠅ⚵ߺ߇ᔅⷐߦߥࠆߣᕁࠊࠇࠆ㧚߹ߚ㧘 㗡∩ᖚ⠪ߪ㎾∩⮎ߩੂ↪ߦࠃࠅ⮎‛ੂ↪㗡∩
߳ߣㅴዷߔࠆน⢻ᕈ߇ࠅ㧘ᶏᄖߢߪ࠻ࡊ࠲ࡦ
ߩੂ↪ߦࠃࠆ⮎‛ੂ↪㗡∩ᖚ⠪߇Ⴧടߒߡ
ࠆ㪉㪊㧘㪉㪋㪀㧚ߒߚ߇ߞߡ㧘ㆡಾߥ⮎ᜰዉࠍⴕ㧘
ᖚ⠪ߩ࡞ࡈࡔ࠺ࠖࠤ࡚ࠪࡦࠍࠨࡐ࠻ߒ㧘⮎
‛ੂ↪㗡∩⊒∝ࠍ੍㒐ߔࠆߎߣ߿㧘⮎‛ੂ↪㗡∩
ߦㅴዷߒߡߒ߹ߞߚ႐วߦߪㅦ߿߆ߦ㗡∩ᄖ᧪㧘
⚻ౝ⑼㧘⣖⚻ᄖ⑼ߥߤ㗡∩ߦߒක≮ᯏ㑐 ߣᖚ⠪ᖱႎࠍߒක≮ㅪ៤ࠍߣࠆߎߣ߽⮎
Ꮷߦߣߞߡ㊀ⷐߣߥࠆߢࠈ߁㪉㪌㪄㪉㪎㪀㧚㩷
࠻ࡊ࠲ࡦ߇ 㪦㪫㪚 ൻߐࠇߚ㓙ߦߪ㧘⮎
Ꮷߩㆡಾߥᖚ⠪್㧘࠻ࡊ࠲ࡦߩലᨐ್ቯߥߤ㧘
⮎ዪ⮎Ꮷߦߪߎࠇ߹ߢએߦ⥃ᐥ⊛್ᢿ⢻ജ ߇᳞ࠄࠇߡߊࠆ㧚ᶏᄖߢߪ㧘⮎Ꮷߩߚߩ㗡
∩ᴦ≮ߩࠟࠗ࠼ࠗࡦ߇ࠆ㪉㪏㪀㧚ᖚ⠪߇ߤߩ⮎ዪ ߦⴕߞߡ߽㧘ᦨㆡߥක≮ߩឭଏࠍฃߌࠆߚߦߪ㧘
࠻ࡊ࠲ࡦߩ 㪦㪫㪚 ൻߣวࠊߖߡ㧘ᧄ㇌ߢ߽
⮎Ꮷߩߚߩࠟࠗ࠼ࠗࡦ߇ᔅⷐߛߣᕁࠊࠇ ࠆ㧚㩷
⻢ ㄉ
ᧄ⎇ⓥߦߏදജ㗂ߚ 㗡∩ᖚ⠪ߩ⊝᭽㧘ᖚ⠪
᭽ࠍߏ⚫㗂ߚᎹ◊ሶవ↢㧘㜞ᯅਂੑవ↢㩿ᤘ
ᄢቇ⮮߇ਐࡂࡆ࠹࡚ࠪࡦ∛㒮 ⚻ౝ
⑼㪀㧘⸻≮㍳⺞ᩏߦߏදജ㗂ߚౝ⮮⚿⧎᳁㩿ᤘ
ᄢቇ∛ᘒ↢ℂቇᢎቶ㧘ᤘᄢቇ∛㒮⮎ㇱ㪀ߦᗵ⻢
⥌ߒ߹ߔ㧚㩷
ᒁ↪ᢥ₂
㪈㪀㩷 㪪㪸㫃㫆㫅㪼㫅㪃㩷 㪩㪅㪑㩷 㪫㪿㪼㩷 㫊㫌㫄㪸㫋㫉㫀㫇㫋㪸㫅㩷 㪻㫀㪽㪽㪼㫉㪼㫅㪺㪼㪅㪃㩷 㪚㪼㫇㪿㪸㫃㪸㫃㪾㫀㪸㪃㩷㪉㪈㪃㩷㪪㪈㪏㪄㪪㪉㪇㩷㩿㪉㪇㪇㪈㪀㪅㩷
㪉㪀㩷 㪡㫆㪿㫅㫊㫋㫆㫅㪃㩷 㪤㪅㪤㪅㪃㩷 㪩㪸㫇㫆㫇㫆㫉㫋㪃㩷 㪘㪅㪤㪅㪑㩷 㪫㫉㫀㫇㫋㪸㫅㫊㩷 㪽㫆㫉㩷 㫋㪿㪼㩷 㫄㪸㫅㪸㪾㪼㫄㪼㫅㫋㩷 㫆㪽㩷 㫄㫀㪾㫉㪸㫀㫅㪼㪅㪃㩷 㪛㫉㫌㪾㫊㪃㩷 㪎㪇㪃㩷 㪈㪌㪇㪌㪄㪈㪌㪈㪏㩷㩿㪉㪇㪈㪇㪀㪅㩷
㪊㪀㩷 㪝㫆㫏㪃㩷 㪘㪅㪮㪅㪑㩷 㪚㫆㫄㫇㪸㫉㪸㫋㫀㫍㪼㩷 㫋㫆㫃㪼㫉㪸㪹㫀㫃㫀㫋㫐㩷 㫆㪽㩷 㫆㫉㪸㫃㩷
㪌㪄㪟㪫㪈㪙㪆㪈㪛㩷 㪸㪾㫆㫅㫀㫊㫋㫊㪅㪃㩷 㪟㪼㪸㪻㪸㪺㪿㪼㪃㩷 㪋㪇㪃㩷 㪌㪉㪈㪄㪌㪉㪎㩷 㩿㪉㪇㪇㪇㪀㪅㩷
㪋㪀㩷 㪤㪸㫋㪿㪼㫎㪃㩷㪥㪅㪫㪅㪃㩷㪪㪺㪿㫆㪼㫅㪼㫅㪃㩷㪡㪅㪃㩷㪮㫀㫅㫅㪼㫉㪃㩷㪧㪅㪃㩷㪼㫋㩷㪸㫃㪅㪑㩷 㪚㫆㫄㫇㪸㫉㪸㫋㫀㫍㪼㩷㪼㪽㪽㫀㪺㪸㪺㫐㩷㫆㪽㩷㪼㫃㪼㫋㫉㫀㫇㫋㪸㫅㩷㪋㪇㩷㫄㪾㩷㫍㪼㫉㫊㫌㫊㩷 㫊㫌㫄㪸㫋㫉㫀㫇㫋㪸㫅㩷 㪈㪇㪇㩷 㫄㪾㪅㪃㩷 㪟㪼㪸㪻㪸㪺㪿㪼㪃㩷 㪋㪊㪃㩷 㪉㪈㪋㪄㪉㪉㪉㩷 㩿㪉㪇㪇㪊㪀㪅㩷
㪌㪀㩷 㪟㪸㫉㪾㫉㪼㪸㫍㪼㫊㪃㩷㪩㪅㪡㪅㪃㩷㪣㫀㫅㪼㫊㪃㩷㪚㪅㪩㪅㪃㩷㪩㪸㫇㫆㫇㫆㫉㫋㪃㩷㪘㪅㪤㪅㪃㩷 㪼㫋㩷 㪸㫃㪅㪑㩷 㪫㪼㫅㩷 㫐㪼㪸㫉㫊㩷 㫆㪽㩷 㫉㫀㫑㪸㫋㫉㫀㫇㫋㪸㫅㪑㩷 㪽㫉㫆㫄㩷 㪻㪼㫍㪼㫃㫆㫇㫄㪼㫅㫋㩷 㫋㫆㩷 㪺㫃㫀㫅㫀㪺㪸㫃㩷 㫊㪺㫀㪼㫅㪺㪼㩷 㪸㫅㪻㩷 㪽㫌㫋㫌㫉㪼㩷 㪻㫀㫉㪼㪺㫋㫀㫆㫅㫊㪅㪃㩷㪟㪼㪸㪻㪸㪺㪿㪼㪃㩷㪋㪐㪃㩷㪪㪊㪄㪪㪉㪇㩷㩿㪉㪇㪇㪐㪀㪅㩷 㪍㪀㩷 ᷡ᳓ବᒾ㧘ဈᢥᒾ㧘↰ਛ੫ሶ㧘ઁ㧦ࠬࡑ࠻
ࡊ࠲ࡦ⥄Ꮖᵈߩ 㗡∩߅ࠃ߮⟲⊒㗡
∩ߦኻߔࠆㅧ⽼ᄁᓟ⺞ᩏᚑ❣㧘ᣂ⮎ߣ⥃ᐥ㧘㩷 㪌㪐㪃㩷㪎㪎㪇㪄㪎㪏㪋㩷㩿㪉㪇㪈㪇㪀㪅㩷
㪎㪀㩷 㪛㫀㪼㫅㪼㫉㪃㩷㪟㪅㪚㪅㪃㩷㪛㫆㫎㫊㫆㫅㪃㩷㪘㪅㪃㩷㪮㪿㫀㪺㫂㪼㫉㪃㩷㪪㪅㪃㩷㪼㫋㩷㪸㫃㪅㪑㩷 㪛㪼㫍㪼㫃㫆㫇㫄㪼㫅㫋㩷 㪸㫅㪻㩷 㫍㪸㫃㫀㪻㪸㫋㫀㫆㫅㩷 㫆㪽㩷 㪸㩷 㫇㪿㪸㫉㫄㪸㪺㫐㩷 㫄㫀㪾㫉㪸㫀㫅㪼㩷 㫈㫌㪼㫊㫋㫀㫆㫅㫅㪸㫀㫉㪼㩷 㫋㫆㩷 㪸㫊㫊㪼㫊㫊㩷 㫊㫌㫀㫋㪸㪹㫀㫃㫀㫋㫐㩷 㪽㫆㫉㩷 㫋㫉㪼㪸㫋㫄㪼㫅㫋㩷 㫎㫀㫋㪿㩷 㪸㩷 㫋㫉㫀㫇㫋㪸㫅㪅㪃㩷 㪡㩷 㪟㪼㪸㪻㪸㪺㪿㪼㩷 㪧㪸㫀㫅㪃㩷 㪐㪃㩷 㪊㪌㪐㪄㪊㪍㪌㩷㩿㪉㪇㪇㪏㪀㪅㩷
㪏㪀㩷 ᣣᧄ㪦㪫㪚ක⮎ຠදળ㪃㩷
㪿㫋㫋㫇㪑㪆㪆㫎㫎㫎㪅㫁㫊㫄㫀㪅㫁㫇㪆㫀㫅㪻㪼㫏㪅㪿㫋㫄㫃㩷 㩿㪉㪇㪈㪈ᐕ㪈㪍ᣣ
㪀㪅㩷
㪐㪀㩷 㪥㪸㫀㫋㫆㪃㩷 㪰㪅㪃㩷 㪠㫊㪿㫀㫀㪃㩷 㪤㪅㪃㩷 㪥㪸㪾㪸㫄㫀㫅㪼㪃㩷 㪘㪅㪃㩷 㪼㫋㩷 㪸㫃㪅㪑㩷 㪘㫊㫊㫆㪺㫀㪸㫋㫀㫆㫅㩷 㫆㪽㩷 㫋㪿㪼㩷 㪘㪄㪈㪋㪊㪏㪞㩷 㫇㫆㫃㫐㫄㫆㫉㫇㪿㫀㫊㫄㩷 㫀㫅㩷 㫊㪼㫉㫆㫋㫆㫅㫀㫅㩷 㪉㪘㩷 㫉㪼㪺㪼㫇㫋㫆㫉㩷 㫀㫅㩷 㫄㫀㪾㫉㪸㫀㫅㪼㩷 㫎㫀㫋㪿㩷 㪸㫌㫉㪸㩷 㪸㫄㫆㫅㪾㩷㪡㪸㫇㪸㫅㪼㫊㪼㩷㫇㪸㫋㫀㪼㫅㫋㫊㪅㪃㩷㪙㫀㫆㫃㩷㪧㪿㪸㫉㫄㩷㪙㫌㫃㫃㪃㩷㪊㪊㪃㩷 㪈㪎㪌㪈㪄㪈㪎㪌㪊㩷㩿㪉㪇㪈㪇㪀㪅㩷
㪈㪇㪀㩷 㪥㪸㫀㫋㫆㪃㩷 㪰㪅㪃㩷 㪠㫊㪿㫀㫀㪃㩷 㪤㪅㪃㩷 㪠㫄㪸㪾㪸㫎㪸㪃㩷 㪘㪅㪃㩷 㪼㫋㩷 㪸㫃㪅㪑㩷 㪘㫊㫊㫆㪺㫀㪸㫋㫀㫆㫅㩷 㪹㪼㫋㫎㪼㪼㫅㩷 㪾㪼㫅㪼㩷 㫇㫆㫃㫐㫄㫆㫉㫇㪿㫀㫊㫄㫊㩷 㪸㫅㪻㩷 㪺㫃㫀㫅㫀㪺㪸㫃㩷 㫉㪼㫊㫇㫆㫅㫊㪼㩷 㫋㫆㩷 㫋㫉㫀㫇㫋㪸㫅㫊㩷 㫀㫅㩷 㫄㫀㪾㫉㪸㫀㫅㪼㪅㪃㩷 㪡㩷 㪧㪿㪸㫉㫄㪸㪺㫆㫃㩷㪪㪺㫀㪃㩷㪈㪇㪐㩷㫊㫌㫇㫇㫃㪅㪈㪃㩷㪈㪋㪏㪧㩷㩿㪉㪇㪇㪐㪀㪅㩷 㪈㪈㪀㩷 㪛㫆㪻㫀㪺㫂㪃㩷 㪤㪅㪛㪅㪑㩷 㪫㫉㫀㫇㫋㪸㫅㩷 㫅㫆㫅㫉㪼㫊㫇㫆㫅㪻㪼㫉㩷 㫊㫋㫌㪻㫀㪼㫊㪑㩷
㫀㫄㫇㫃㫀㪺㪸㫋㫀㫆㫅㫊㩷㪽㫆㫉㩷㪺㫃㫀㫅㫀㪺㪸㫃㩷㫇㫉㪸㪺㫋㫀㪺㪼㪅㪃㩷㪟㪼㪸㪻㪸㪺㪿㪼㪃㩷㪋㪌㪃㩷 㪈㪌㪍㪄㪈㪍㪉㩷㩿㪉㪇㪇㪌㪀㪅㩷
㪈㪉㪀㩷 ኹᧄ ⚐㧦࠻ࡊ࠲ࡦήലߩᬌ⸛㧘ᣣᧄ㗡
∩ቇળ㪃㩷㪊㪇㪃㩷㪈㪍㪋㪄㪈㪍㪍㩷㩿㪉㪇㪇㪊㪀㧚㩷
㪈㪊㪀㩷 ኹᧄ ⚐㧦ࠬࡑ࠻ࡊ࠲ࡦ㧘࠱࡞ࡒ࠻ࡊ࠲
ࡦ㧘ࠛ࠻ࡊ࠲ࡦߩᚑ❣Ყセ㧘ᣣᧄ㗡∩ቇ ળ㧘㪊㪈㪃㩷㪈㪐㪄㪉㪈㩷㩿㪉㪇㪇㪋㪀㪅㩷
㪈㪋㪀㩷 ┙ጟ⦟ਭ㧦 㗡∩ᖚ⠪߳ߩ⮎ᜰዉߩ㊀ⷐᕈ 㪄࠻ࡊ࠲ࡦ⮎ߩᦨㆡൻࠍ⋡ᜰߒߡ㪄㧘
⸻ᢿߣᴦ≮㧘㪐㪊㧘㪈㪏㪌㪐㪄㪈㪏㪍㪌㩷㩿㪉㪇㪇㪌㪀㧚㩷 㪈㪌㪀㩷 ᣣᧄ㗡∩ቇળ✬㧦ᘟᕈ㗡∩ߩ⸻≮ࠟࠗ࠼ࠗ
ࡦ㧘කቇᦠ㒮㧘᧲੩㩷 㩿㪉㪇㪇㪍㪀㧚㩷
㪈㪍㪀㩷 㪧㪸㫊㪺㫌㪸㫃㪃㩷㪡㪅㪃㩷㪝㫀㫋㪼㪃㩷㪙㪅㪃㩷㪣㫆㫇㪼㫑㪄㪞㫀㫃㪃㩷㪘㪅㪑㩷㪚㫆㫄㫇㪸㫉㫀㫊㫆㫅㩷 㫆㪽㩷 㫋㫉㫀㫇㫋㪸㫅㩷 㫋㪸㪹㫃㪼㫋㩷 㪺㫆㫅㫊㫌㫄㫇㫋㫀㫆㫅㩷 㫇㪼㫉㩷 㪸㫋㫋㪸㪺㫂㪑㩷 㪸㩷 㫇㫉㫆㫊㫇㪼㪺㫋㫀㫍㪼㩷 㫊㫋㫌㪻㫐㩷 㫆㪽㩷 㫄㫀㪾㫉㪸㫀㫅㪼㫌㫉㫊㩷 㫀㫅㩷 㪪㫇㪸㫀㫅㪅㪃㩷 㪟㪼㪸㪻㪸㪺㪿㪼㪃㩷㪋㪉㪃㩷㪐㪊㪄㪐㪏㩷㩿㪉㪇㪇㪉㪀㪅㩷
㪈㪎㪀㩷 ┻ፉᄙ⾐ᄦ㧘ච፲ਭ૫㧘ự↰Ả৻㧘ઁ㧦ࠬ
ࡑ࠻ࡊ࠲ࡦ㩿ࠗࡒࠣࡦᵈ㍤
ὐ㥦ᶧ㪀ߩ 㗡∩ࠆߪ⟲⊒㗡∩ߦኻߔࠆ Ꮢ⽼ᓟ⺞ᩏᚑ❣ ↪ᚑ❣⺞ᩏ㪎㧘㪇㪇㪇ߩ
㓸ᖱႎࠃࠅ㧘⸻ᢿߣᴦ≮㧘㪐㪋㧘㪉㪈㪋㪐㪄㪉㪈㪍㪏㩷㩿㪉㪇㪇㪍㪀㧚㩷 㪈㪏㪀㩷 ⨹ᧁᴦሶ㧘┻ፉᄙ⾐ᄦ㧘ේ⪲ሶ㧘ઁ㧦㠽ข
ᄢቇ⚻ౝ⑼㗡∩ᄖ᧪ߦ߅ߌࠆ࠻ࡊ࠲ࡦ ߩᬌ⸛㧘ᣣᧄ㗡∩ቇળ㧘㩷 㪊㪈㪃㩷㪐㪏㪄㪈㪇㪇㩷 㩷 㩿㪉㪇㪇㪋㪀㧚㩷 㪈㪐㪀㩷 㪤㪸㫅㫅㫀㫏㪃㩷 㪣㪅㪢㪅㪃㩷 㪪㪸㫍㪸㫅㫀㪃㩷 㪥㪅㪃㩷 㪣㪸㫅㪻㫐㪃㩷 㪪㪅㪃㩷 㪼㫋㩷 㪸㫃㪅㪑㩷
㪜㪽㪽㫀㪺㪸㪺㫐㩷 㪸㫅㪻㩷 㫋㫆㫃㪼㫉㪸㪹㫀㫃㫀㫋㫐㩷 㫆㪽㩷 㫅㪸㫉㪸㫋㫉㫀㫇㫋㪸㫅㩷 㪽㫆㫉㩷 㫊㪿㫆㫉㫋㪄㫋㪼㫉㫄㩷 㫇㫉㪼㫍㪼㫅㫋㫀㫆㫅㩷 㫆㪽㩷 㫄㪼㫅㫊㫋㫉㫌㪸㫃㫃㫐㩷 㫉㪼㫃㪸㫋㪼㪻㩷 㫄㫀㪾㫉㪸㫀㫅㪼㪑㩷㪻㪸㫋㪸㩷㪽㫉㫆㫄㩷㫋㫎㫆㩷㫉㪸㫅㪻㫆㫄㫀㫑㪼㪻㪃㩷㪻㫆㫌㪹㫃㪼㪄㪹㫃㫀㫅㪻㪃㩷 㫇㫃㪸㪺㪼㪹㫆㪄㪺㫆㫅㫋㫉㫆㫃㫃㪼㪻㩷 㫊㫋㫌㪻㫀㪼㫊㧚㧘㩷 㪟㪼㪸㪻㪸㪺㪿㪼㪃㩷 㪋㪎㪃㩷 㪈㪇㪊㪎㪄㪈㪇㪋㪐㩷㩿㪉㪇㪇㪎㪀㪅㩷
㪉㪇㪀㩷 㪤㪸㪺㪞㫉㪼㪾㫆㫉㪃㩷㪜㪅㪘㪅㪃㩷㪟㪸㪺㫂㫊㪿㪸㫎㪃㩷㪘㪅㪑㩷㪧㫉㪼㫍㪸㫃㪼㫅㪺㪼㩷㫆㪽㩷 㫄㫀㪾㫉㪸㫀㫅㪼㩷 㫆㫅㩷 㪼㪸㪺㪿㩷 㪻㪸㫐㩷 㫆㪽㩷 㫋㪿㪼㩷 㫅㪸㫋㫌㫉㪸㫃㩷 㫄㪼㫅㫊㫋㫉㫌㪸㫃㩷 㪺㫐㪺㫃㪼㪅㪃㩷㪥㪼㫌㫉㫆㫃㫆㪾㫐㪃㩷㪍㪊㪃㩷㪊㪌㪈㪄㪊㪌㪊㩷㩿㪉㪇㪇㪋㪀㪅㩷
㪉㪈㪀㩷 㪞㫉㪸㫅㪼㫃㫃㪸㪃㩷 㪝㪅㪃㩷 㪪㪸㫅㪺㪼㫊㪃㩷 㪞㪅㪃㩷 㪘㫃㫃㪸㫀㫊㪃㩷 㪞㪅㪃㩷 㪼㫋㩷 㪸㫃㪅㪑㩷 㪚㪿㪸㫉㪸㪺㫋㪼㫉㫀㫊㫋㫀㪺㫊㩷 㫆㪽㩷 㫄㪼㫅㫊㫋㫉㫌㪸㫃㩷 㪸㫅㪻㩷 㫅㫆㫅㫄㪼㫅㫊㫋㫉㫌㪸㫃㩷 㪸㫋㫋㪸㪺㫂㫊㩷 㫀㫅㩷 㫎㫆㫄㪼㫅㩷 㫎㫀㫋㪿㩷 㫄㪼㫅㫊㫋㫉㫌㪸㫃㫃㫐㩷 㫉㪼㫃㪸㫋㪼㪻㩷 㫄㫀㪾㫉㪸㫀㫅㪼㩷 㫉㪼㪽㪼㫉㫉㪼㪻㩷 㫋㫆㩷 㪿㪼㪸㪻㪸㪺㪿㪼㩷 㪺㪼㫅㫋㫉㪼㫊㪅㪃㩷 㪚㪼㫇㪿㪸㫃㪸㫃㪾㫀㪸㪃㩷㪉㪋㪃㩷㪎㪇㪎㪄㪎㪈㪍㩷㩿㪉㪇㪇㪋㪀㪅㩷
㪉㪉㪀㩷 ⍹ᱜ㧘㐳Ꭸ ᱠ㧘ᧁ㚅㧘ઁ㧦 㗡∩
ࠬࠢ࠽ߪ⮎ዪ⮎Ꮷߦࠃࠆ 㗡∩ᖚ
⠪ߩ್ߦ↪߆㧫㧘⮎ቇ㔀㧘㪈㪊㪇㪃㩷㪏㪏㪈㪄㪏㪏㪎㩷 㩿㪉㪇㪈㪇㪀㪅㩷
㪉㪊㪀㩷 㪢㪸㫋㫊㪸㫉㪸㫍㪸㪃㩷 㪱㪅㪃㩷 㪛㫀㪼㫅㪼㫉㪃㩷 㪟㪅㪚㪅㪑㩷 㪤㪼㪻㫀㪺㪸㫋㫀㫆㫅㩷 㫆㫍㪼㫉㫌㫊㪼㩷㪿㪼㪸㪻㪸㪺㪿㪼㩷㫀㫅㩷㪞㪼㫉㫄㪸㫅㫐㪅㪃㩷㪚㪼㫇㪿㪸㫃㪸㫃㪾㫀㪸㪃㩷㪉㪏㪃㩷 㪈㪉㪉㪈㪄㪈㪉㪉㪉㩷㩿㪉㪇㪇㪏㪀㪅㩷
㪉㪋㪀㩷 㪛㫆㪻㫀㪺㫂㪃㩷㪛㪅㪮㪅㪃㩷㪪㫀㫃㪹㪼㫉㫊㫋㪼㫀㫅㪃㩷㪪㪅㪛㪅㪑㩷㪟㫆㫎㩷㪺㫃㫀㫅㫀㪺㫀㪸㫅㫊㩷 㪺㪸㫅㩷 㪻㪼㫋㪼㪺㫋㪃㩷 㫇㫉㪼㫍㪼㫅㫋㩷 㪸㫅㪻㩷 㫋㫉㪼㪸㫋㩷 㫄㪼㪻㫀㪺㪸㫋㫀㫆㫅㩷 㫆㫍㪼㫉㫌㫊㪼㩷㪿㪼㪸㪻㪸㪺㪿㪼㪅㪃㩷㪚㪼㫇㪿㪸㫃㪸㫃㪾㫀㪸㪃㩷㪉㪏㪃㩷㪈㪉㪇㪐㪄㪈㪉㪈㪎㩷 㩿㪉㪇㪇㪏㪀㪅㩷
㪉㪌㪀㩷 ౝ⮮⚿⧎㧘⍹ᱜ㧘Ꮉฬᘮᴦ㧘ઁ㧦㗡∩ᖚ
⠪ߩ࡞ࡈࡔ࠺ࠖࠤ࡚ࠪࡦߦ߅ߌࠆ㒾
⮎ዪ⮎Ꮷߩᓎഀ㧘⮎ቇ㔀㧘㪈㪉㪐㧘㪎㪊㪌㪄㪎㪋㪇㩷 㩿㪉㪇㪇㪐㪀㧚㩷
㪉㪍㪀㩷 ౝ⮮⚿⧎㧘⍹ᱜ㧘ဈ↱⾆㧘ઁ㧦㗡∩ක
≮ߦ߅ߌࠆ㒾⮎ዪߣ∛㒮⸻≮ᚲߣߩක≮
ㅪ៤ߩᔅⷐᕈ㧘⮎ቇ㔀㧘㪈㪉㪐㧘㪎㪋㪈㪄㪎㪋㪏㩷㩿㪉㪇㪇㪐㪀㧚㩷 㪉㪎㪀㩷 㐳Ꭸ ᱠ㧘⍹ᱜ㧘ౝ⮮⚿⧎㧘ઁ㧦㗡∩ࠤ
ࠕߦ߅ߌࠆ࠼࠶ࠣࠬ࠻ࠕ⮎Ꮷߩᓎഀ㧦
࡞ࡈࡔ࠺ࠖࠤ࡚ࠪࡦߩࠨࡐ࠻ߣක≮ㅪ ៤ߩᔅⷐᕈ㧘ᤘᄢቇ⮎ቇ㔀㧘㪈㧘㪈㪍㪌㪄㪈㪎㪉㩷 㩿㪉㪇㪈㪇㪀㧚㩷
㪉㪏㪀㩷 㪤㫀㪾㫉㪸㫀㫅㪼㩷 㫀㫅㩷 㪧㫉㫀㫄㪸㫉㫐㩷 㪚㪸㫉㪼㩷 㪘㪻㫍㫀㫊㫆㫉㫊㪑㩷 㪞㫌㫀㪻㪼㫃㫀㫅㪼㫊㩷 㫆㫅㩷 㪿㪼㪸㪻㪸㪺㪿㪼㩷 㫄㪸㫅㪸㪾㪼㫄㪼㫅㫋㩷 㪽㫆㫉㩷 㫌㫊㪼㩷 㪹㫐㩷 㫋㪿㪼㩷 㫇㪿㪸㫉㫄㪸㪺㫀㫊㫋㪅㩷 㪿㫋㫋㫇㪑㪆㪆㫎㫎㫎㪅㫄㫀㫇㪺㪸㪅㩷㫆㫉㪾㪅㫌㫂㪆㫀㫅㪻㪼㫏㪅㪿㫋㫄㫃㩷㩿㪉㪇㪈㪈ᐕ㪈㪍 ᣣ㪀㧚㩷
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Treatment of Non-Responders and Poor Responders to Triptan in Patients with Migraine
Yuki Sakairi1, Masakazu Ishii1*, Hajime Hara2, Shunichi Shimizu1, Shino Usami1,3, Yuji Kiuchi4
㪈㩷 㪛㪼㫇㪸㫉㫋㫄㪼㫅㫋㩷㫆㪽㩷㪧㪸㫋㪿㫆㫇㪿㫐㫊㫀㫆㫃㫆㪾㫐㩷㪸㫅㪻㩷 㩷㪋㩷㪚㪼㫅㫋㪼㫉㩷 㫆㪽㩷 㪧㪿㪸㫉㫄㪸㪺㪼㫌㫋㫀㪺㪸㫃㩷 㪜㪻㫌㪺㪸㫋㫀㫆㫅㪃㩷 㪪㪺㪿㫆㫆㫃㩷 㫆㪽㩷 㪧㪿㪸㫉㫄㪸㪺㫐㪃㩷 㪪㪿㫆㫎㪸㩷㪬㫅㫀㫍㪼㫉㫊㫀㫋㫐㪃㩷㪈㪄㪌㪄㪏㩷㪟㪸㫋㪸㫅㫆㪻㪸㫀㪃㩷㪪㪿㫀㫅㪸㪾㪸㫎㪸㪄㫂㫌㪃㩷㪫㫆㫂㫐㫆㩷㪈㪋㪉㪄㪏㪌㪌㪌㪃㩷㪡㪸㫇㪸㫅㩷
㪉㩷 㪛㪼㫇㪸㫉㫋㫄㪼㫅㫋㩷 㫆㪽㩷 㪥㪼㫌㫉㫆㫃㫆㪾㫐㪃㩷 㪪㪿㫆㫎㪸㩷 㪬㫅㫀㫍㪼㫉㫊㫀㫋㫐㩷 㪝㫌㫁㫀㪾㪸㫆㫂㪸㩷 㪩㪼㪿㪸㪹㫀㫃㫀㫋㪸㫋㫀㫆㫅㩷 㪟㫆㫊㫇㫀㫋㪸㫃㪃㩷 㪉㪄㪈㪄㪈㩷 㪝㫌㫁㫀㪾㪸㫆㫂㪸㪃㩷 㪘㫆㪹㪸㪄㫂㫌㪃㩷㪰㫆㫂㫆㪿㪸㫄㪸㪄㫊㪿㫀㪃㩷㪢㪸㫅㪸㪾㪸㫎㪸㩷㪉㪉㪎㪄㪏㪌㪈㪏㪃㩷㪡㪸㫇㪸㫅㩷
㪊㩷 㪬㫊㪸㫄㫀㩷㪥㪼㫌㫉㫆㫊㫌㫉㪾㪼㫉㫐㩷㪚㫃㫀㫅㫀㪺㪆㪠㫅㫊㫋㫀㫋㫌㫋㪼㪃㩷㪌㪄㪈㪏㪃㩷㪢㫀㫋㪸㫄㫀㫅㪼㫄㪸㪺㪿㫀㪃㩷㪦㪿㫋㪸㪄㫂㫌㪃㩷㪫㫆㫂㫐㫆㩷㪈㪋㪌㪄㪇㪇㪎㪊㪃㩷㪡㪸㫇㪸㫅㩷 㩷
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Abstract
Triptans are manufactured in five compounds and four dosage forms for use as antimigraine agents in Japan. Since triptans that include sumatriptan and naratriptan are available as over-the-counter (OTC) drugs in other countries, triptans are expected to become OTC drugs in Japan in the future. About 30% of patients have an insufficient response to triptan, even though they have timed the administration of triptan appropriately. For a non-responder or a poor responder, it is necessary to examine another type or dosage form of triptans. Therefore, pharmacists in community pharmacies must distinguish patients who need triptans, select an appropriate triptan for individual patients, and treat patients who are non-responders or poor responders to triptans. In this study, we describe patients with migraine who obtained a sufficient effect of triptan after the type of triptan was changed. Moreover, we discuss the need for clinical competence among pharmacists in community pharmacies.
Key Words㧦migraine, triptan, pharmacist
㪩㪼㪺㪼㫀㫍㪼㪻㩷㪉㪇㩷㪛㪼㪺㪼㫄㪹㪼㫉㩷㪉㪇㪈㪇㪒㩷㪸㪺㪺㪼㫇㫋㪼㪻㩷㪐㩷㪝㪼㪹㫉㫌㪸㫉㫐㩷㪉㪇㪈㪈㪅㩷 㩷
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